HEALTH CHECK-UP via WEB
M illions ot Americans turn to websites for medical and healing information. Since many of these sites are for-profit ventures, how can a consumer be sure that the advice a medical site dispenses is reliable arid uninfluenced by commercial considerations?
To help answer this question, we have evaluated five popular sites based on the following criteria: their source(s) of information, stated policies regarding the separation of advertising and editorial content, how the sites identity advertising or sponsored sections, and other factors that will help anyone sort through the material that’s out there.
The site, which had 3.6 million visitors in November 1999, offers an impressive lineup of features, including: daily news, stories; sections on topics like aging and women’s health; community chat rooms; and health-related products and services.
INFORMATION SOURCE: Former U.S. surgeon general C. Everett Koop, the site’s chairman, has little day-to-day involvement with the site. Koop regularly produces medical advice columns, occasionally reviews articles, and suggests story topics, says Dennis Upah, the site’s chief operating officer.
The site’s content comes from a range of sources; most of it is produced by a staff of medical writers and then reviewed by Dartmouth Medical School faculty members at least once a year. (Koop is on Dartmouth’s faculty.) Other information conies directly from Dartmouth faculty or educators at other medical institutions. Additional material from such government organizations as the National Institutes of Health; wire service reports; and non-profit groups like the National Council on Patient Information and Education also runs on the site. A partial list of content providers, or “partners” is buried within the “Corporate Information” section of the “About Us” pages.
POLICIES: Last September, 1998, The New York Times reported that Koop was receiving royalties on every product sold on the site, and that 14 health-care facilities had each paid $40,000 to be included in drkoop.com’s list of “the most innovative and advanced health care institutions across the country.” Since then, Koop has stopped receiving royalties, and the site openly discloses that hospitals pay a fee to be placed on the list. Also, Koop has become a vocal proponent of establishing selfregulating guidelines for medical websites.
The “Code of Ethics” on the “Message From Dr. Koop” page includes a promise to reveal content sources (which the site does) and to provide timely, accurate, and unbiased information. Its hard-to-find advertising policy promises editorial objectivity. Like all the other sites we evaluated, drkoop.com says that it abides by the “Code of Conduct” put out by Switzerland’s Health on the Net (HUN) Foundation, an international nonprofit group that promotes the use of the Internet in the fields of medicine and health. The code stresses the importance of ad-edit separation; any site that agrees to follow the code can display the HON logo. But this stamp of approval carries little weight, says Joel Kahn, MD, of the medical site InteliHealth.com, since anyone can use the HON emblem simply by promising to adhere to the code. HON’s own site explains that it relies on “members of the Net community” to alert the organization to any violations
ADS/SPONSORSHIPS: Ads on the site are unlabeled. They appear either in top-of-the-page banners or iii side-bars. Advertisers generally target specific sections for their ads to appear in. “If you’re reading about elderly diseases,” Upah notes, “such as osteoporosis, you’re likely to find [ads for] Geritol...or other products that are of interest to folks in that demographic [in that section].”
Sponsors for everything from online chats to special sections are clearly labeled with a caption, and a note at the bottom of drkoop.com’s home page lists all sponsored sections: For example, the “Nutrition Center” is sponsored by VitaminShoppe.com. Sponsorship does not mean that a company has any influence over editorial content, according to Upah. The site’s Mental Health Center is produced “in cooperation with” the mental health site Lifescape.com. This means, Upah says, that material has come from Lifescape.com but that no financial relationship exists.
OTHER FACTORS TO KEEP IN MIND:
The American Council on Science and Health (ACSH) occasionally provides drkoop.com with articles. Although the site identifies ACSH as a “public- health, consumer education consortium,” browsers should know that ACSH receives approximately half its funding from petrochemical corporations like Monsanto Company, The Dow Chemical Company, and The Proctor & Gamble Company.
Also, drkoop.com promotes clinical drug trials administered by the for-profit Quintiles Transnational Corp.; the site receives a commission on successful referrals. This financial arrangement was revealed in the New York Times article; before then, the site heralded Quintiles as “the world’s leading clinical organization” without acknowledging that it receives commissions. The nature of the relationship is now disclosed on the site.
TnteliHealth, a joint voiiture between Aetna U.S. Healthcare and Johns Hopkins University and Health System, offers daily health news articles and a Q&A section where users can seek medical advice and guidance from Johns Hopkins staffers. The articles are occasionally accompanied by explanatory comments from a Johns Hopkins health professional. InteliHealthi’s Drug Resource Center includes a searchable drug index, pharmaceutical news stories, and a section that tracks FDA approval of drugs. An online store, lnteliHealth Healthy Home, sells health-related products.
INFORMATION SOURCE: Portions of the site are written by Hopkins health-care professionals, while other sections, such as entries in the “A to Z Disease and Condition Guide,” are contributed by staff writers. According to InteliHealth executive vice-president Joel Kahn, MD, the content is reviewed by a Hopkins professional before it appears on the site. We checked two items on InteliHealth to see whether the procedure had been followed—and found that it had. InteliHealth also accepts material from other organizations, such as the American Medical Association and The Associated Press, once a Hopkins staffer deems it trustworthy.
Outside sources of news articles are clearly noted at the top of the text. InteliHealth runs a partial list of its out-side content providers within the “Disclaimer” section. According to Kahn, all JnteliHealth content is reviewed every two years; the last review date appears at the bottom of an item.
POLICIES: Look for the site’s self-imposed guidelines (similar to drkoop.com’s) regarding editorial independence under “Our Advertising Philosophy,” located within the “Disclaimer” page. That page also notes that neither IntehiHealth nor Johns Hopkins endorses the products sold by Healthy Home.
ADS/SPONSORSHIPS: Except for banners, all advertisements—even those for Healthy Home—are labeled with captions. Advertisers can target specific audiences for their products. For example, the company that produces Tylenol Arthritis painkiller runs a banner ad across the top of JnteliHealth’s “Arthritis Zone.” Nowhere does the site post a sponsor list, but it clearly identifies sponsors of individual sections: An icon in the top right corner of the “Drug Resource Center” page tells users that drugstore.com, a pharmaceLlticab e-commerce site, is a sponsor. Other site sponsors include major pharniaceutical companies like Johiison & Johnson and SmithKline Bcechaiii Pharmaceuticals. According.to (olin, sponsors have no influence over a section’s editorial content.
MAYO CLINIC HEALTH OASIS
“The most important commodity in this whole Internet era is credibility and authority,” says Brooks Edwards, MD, medical editor of this nonprofit site. “It’s like virginity: If you lose it, you never get it back.” Health Oasis’s credibility stems largely from its relationship with Minnesota’s venerable Mayo Clinic. Oasis otters a “Headline Watch” of the day’s breaking health news; illustrated sections on ailments ranging from asthma to cancer; links to other medcal sites; and “Ask the Mayo Physician,” a Q&A section.
INFORMATION SOURCE: Most of Oasis’s content is written by seasoned medical writers, and every article is reviewed by three Mayo Clinic health-care providers. The site’s editors regularly turn to any of the 2,000 Mayo Clinic physicians to submit articles, review content, and suggest story ideas. On average, about 40 medical professionals contribute to the site each month, according to Mayo Clinic spokesperson Suzanne Leaf-Brock. Oasis boasts that Mayo professionals check on the information’s timeliness, and they guarantee at least one check every three years. Certain sections are updated regularly, according to Edwards, like “Headline Watch” (updated five times a week). Other stories remain posted for as long as they are relevant.
POLICIES: The “About Oasis” section details the site’s advertising policy: Ads are clearly labeled, it notes, and are separated from editorial content. The section explains that Oasis doesn’t endorse any products or companies that advertise on the site.
ADS/SPONSORSHIPS: Oasis labels all ads, including banners, using the word “advertisers” or “sponsors.” Here, too, sponsorship means companies can fund specific sections but cannot interfere with the section’s content.
OTHER FACTORS: The site sells Mayo Clinic publications, and proceeds help fund the site, the clinic, and the research center. Sometime in the spring of 2000, Oasis will be folded into a new, for-profit “supersite,” which, according to Edwards, will be more personalized and interactive. The new site will advertise more extensively and will be administered by a new, private company funded by outside investors. Edwards expects that the site’s current ad, sponsorship, and content policies will remain the same.
Mediconsults notable feature is its in-depth information on more than 60 chronic medical conditions, from prostate cancer to diabetes. For each medical condition, Mediconsult offers journal articles, drug information, medical news, links to relevant sites, and listings of clinical trials. Also, noteworthy is its comprehensive drug center, organized by medical condition as well as by brand and generic drug name. Additional features include support groups and live chats. All live events and support groups are moderated by medical professionals, so every single posting is reviewed before it goes live,” according to Mediconsult president Jan Sutclitfe.
INFORMATION SOURCE: Most of Mediconsults writers have a nursing or medical resident background. Original stories are based on medical journal reports, medical conference news, and news wire stories (wire reports are checked for accuracy against articles in peer-reviewed journals before appearing on the site). Articles are dated and reviewed for currency at least once a year, or when changes in medicine and research affect accuracy. Among Mediconsults partnerships with outside sources is its deal with the Canadian TV newsmagazine Doctor On Call to post articles from the program on the site.
POLICIES: A “Statement of Editorial Independence” in the site’s “About Us” section vaguely declares that Mediconsult accepts only ads that “bring value to” the site community. According to the policy, Mediconsult controls all written and graphic content and discloses all sources of information, and advertisers are clearly identified (the words advertisers and sponsors are used interchangeably).
ADS/SPONSORSHIPS: Mediconsult stopped selling banner ads in October, 1999. It now focuses on soliciting sponsorship for pages on the site. All sponsors are listed on a page in Mediconsult’s “Site Services” section. By sponsoring a section, however, companies can post banner and sidebar ads on Mediconsult. For example, ads for Laser Vision Centers and the drug Avandia are promineiitly featured and unlabeled.
OTHER FACTORS: Mediconsult provides clinical drug trial information the CenterWatch Clinical Trials Listing Service. Unlike drkoop.com, the site does not receive commissions on successful referrals.
WebMD.com resulted from a $4.8 billion merger last November, 1999, between Healtheon Corporation and WebMD, Inc. Among the consumer services the site offers are daily health news stories; guides to prescription and over-the-counter drugs; information on clinical trials; and an online “community” of bulletin boards and discussion groups.
INFORMATION SOURCE: WebMD’s 60 qualified medical journalists write all of WebM D’s health news stories. All 60 have passed medical knowledge tests administered by WebMD. Some have passed a similar test administered by the American Medical Writers Association, and 25 are board certified physicians. They cull their information from peer-reviewed medical journals and papers. WebMD’s original stories run with bylines and are reviewed by a physician before appearing online. WebMD also posts information from medical associations, such government agencies as the Centers for Disease Control and Prevention, medical publishers, and educational institutions, like the Yale University School of Medicine. The site’s “Medical Library” has a partial list of outside content sources.
WebMD’s physicians and outside experts update the site’s original material about four times a year. The site does not guarantee the timeliness of content provided by outside sources.
POLICIES: WebMD’s “Our Credentials” section includes “The WebMD News s. Credo of Editorial Independence,” which explains that all editorial staffers must disclose any potential conflicts of interest, such as a financial stake in pharmaceutical company, when applying for a position. The “What We Do” assurance says WebMD clearly distinguishes news from other information on the site. And the “WebMD Advertising & Promotions Policy” claims that “all advertising content..shall be clearly and unambiguously identified as such
ADS/SPONSORSHIPS: In April, 1999, E. I. DuPont de Nemours and Company, a maker of science-based food products, became the sites exclusive provider of life sciences information. So far, only the site’s soy protein section has been developed under this agreement In the section, which touts the benefits of a diet with a high soy cornpoiient, a banner explains that it is produced in partnership with Protein Technologies International, a du Pont business. Unlike sponsorship deals on the other sites, Protein Technologies does produce content for the section. So far, du Pont is the only corporation to have sponsored a sectioii, but according to Nan Forte, WebMD executive vice-president of consumer portal and strategic media, the site will have three or tour additional sponsors by the end of March. Forte says a site list of all sponsors is in the works.
OTHER FACTORS: News Corporation is a 10.8 % shareholder in Healtheon/ WebMD. Under the partnership, WebMD provides content to, among others, Fox Broadcasting and the New York Post. Healtheon/WebMD also has partnerships with Microsoft and Lycos to provide the company’s portals with coiitent.
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